Affordable Care Act Legislation requires all health insurance companies to submit their price increase requests to the federal or state government. Carriers across the US have requested rate changes for 2018 individual and employer-provided plans. Many companies are no longer offering private medical coverage, or renewing any existing plans. Grandfathered plans, however, continue to be renewed.

Below, we have provided details of the proposed price increases (and decreases). The Ohio Department of Insurance will determine what amount (full or partial) will be granted for January 1, 2018 effective dates. Companies and their requests are listed in alphabetical order. Carriers offering off-Exchange plans are not listed. Non-compliant short-term plans are also not listed.

Ohio health insurance availability has taken another major hit with the exit of Anthem Blue Cross Blue Shield and Premier. Suddenly, the Buckeye State, in many counties, will no longer offer a plentiful number of medical plan options through the subsidized Marketplace. Previously, Aetna, UnitedHealthcare, and Humana announced they will not offer private individual or family plans through the Exchanges. More than 10,000 persons in 18 counties no longer have participating carriers offering Marketplace coverage. Rate volatility and unpredictable company choices are continuing concerns.

However, Senior Medigap contracts, including Advantage, Supplement, and Part D prescription drug plans remain unaffected. Other ancillary products will continue to be offered, including dental, vision, life, critical-illness, and short-term plans. Group coverage offered by small and large businesses will also not be impacted by the erosion of the Affordable Care Act (Obamacare). Grandfathered and grandmothered plans are also not affected. Short-term health insurance plans continue to be available, although they are not compliant with current legislation, and do not cover pre-existing conditions.

Hey Kid! You Won’t Find Anthem Or Premier Down There!

Anthem

Current policyholders will be receiving an email detailing the effective date of termination (December 31), and verification that their current coverage is compliant with ACA guidelines. “Continual changes” and lack of predictability” were reasons cited by Anthem for their exit. Wisconsin and Indiana are two additional states that Anthem will either leave or only offer coverage in limited areas.

Although Anthem’s Ohio rates have not been especially competitive the last few years, 2017 coverage is offered in every county, and they are one of the few carriers that offer HSA plans through the federal Exchange. Popular plan options available that will not be offered in 2018 include Bronze Pathway PPO 5150, Bronze Pathway PPO 0% For HSA, Bronze Pathway HMO 5000, Silver Pathway PPO 2000, and Silver Pathway PPO 3000.

Premier

Dayton-based Premier Health Plan serves areas of Southwestern Ohio with individual, family, Senior, and Group coverage. Rates have been most competitive in Warren, Montgomery, and Greene Counties. An additional six counties are in the service area. However, after featuring extremely competitive rates in 2016, Premier substantially raised premiums for 2017 effective dates, and still has been struggling in the Under-65 market. Although customer satisfaction has been high, competition from other carriers kept Premier from sustaining significant growth.

Policies no longer available for 2018 include Health One Bronze 7150, Health One Bronze 6550, Health One Bronze 6250, Health One Bronze 6500, Health One Silver 5000, Health One Silver 4750, Health One Silver 4500, Health One Silver 3250, Health One Silver 3000, and Health One Gold 1750. Current customers can retain their existing policies through December 31st.

Future Healthcare Legislation

The current Administration, is attempting to repeal and replace The Affordable Care Act (aka Obamacare), with new legislation that could possibly reduce health insurance costs, and offer more customized low-cost plans. With less than three weeks left until a summer recess, Senate Majority Leader Mitch McConnell needs further compromises to pass a partisan bill.

Ohio Medicaid Health Insurance is available to many Buckeye State residents. Medical plans are currently provided to more than three million individuals and families, with pre-existing conditions covered, and premiums either free or extremely inexpensive. Comprehensive benefits are provided after a short application is submitted and approved. Food and cash assistance, help with housing and utilities, and mental health and addiction services are also offered through other Agencies.

The two public assistance cards are “Direction” and “EPPIC.” If you currently utilize either of the cards, an additional application is not needed. Veterans or persons serving in the Military may have additional options. WIC (women, infants, and children) offers supplementary nutrition assistance to breastfeeding and pregnant women, and children less than five years old. Nutrition and breastfeeding education, and specific foods (eggs, vegetables, fruits, whole grains) are provided to eligible persons. Infant mortality has been greatly reduced, while birth weight and length of pregnancy have increased, due to WIC and other similar programs.

Qualifications

Applicants that can qualify for benefits include individuals with low income, persons with disabilities, older adults, infants, small children, and pregnant women. Additional requirements are US citizenship, legally reside in Ohio, and be able to meet specific income guidelines. Applications can be submitted online or through the mail. A personal visit is not required. Non US citizens that are ineligible for coverage can apply for alien emergency medical assistance or refugee medical assistance. Refugees who have been in the US less than eight months, and are ineligible for Medicaid, may be able to receive benefits if their household income is less than 100% of the poverty level.

CHIP and Medicaid eligibility is largely determined by the MAGI (Modified Adjusted Gross Income). Of course, the more money the household earns, the less federal or state funds are provided. You can view specific information regarding the calculation here. Expansion has taken place in many states (including Ohio), so more applicants are now eligible. “Healthy Start” and “Healthy Families” are available to state residents that have a social security number and meet certain financial requirements.

Healthy Start

“Healthy Start” (also known as “SCHIP”) is available to uninsured children (19 and under) with household income up to 206% of the Federal Poverty Level (FPL). Applicants must be a US citizen, permanent resident, or legal alien. Any person that has illegally entered the United States will not be eligible for benefits.

Pregnant women in families with income up to 200% of the FPL and covered children (19 and under) with household income up to 156% of the FPL also qualify. There is no pre-existing condition clause, or waiting period for treatment, once enrolled in the program. After becoming eligible for Medicaid, each child will have access to Healthchek, Ohio’s early and periodic screening, diagnosis and treatment program.

“Healthy Families” is offered to families, with a child under age 19, that have income no higher than 90% of the Federal Poverty Level. Coverage is available to the adults, but not children. Applicants must be a US citizen and a legal resident of Ohio. There is no cost to enroll or secure coverage. Once approved for Medicaid, fee-for-service benefits begin, although you are required to re-apply every six months. Proof of US citizenship and income will be required.

Household income will be re-calculated every six months to ensure continued eligibility. Case workers should always be informed of changes that impact income or eligibility. Once approved, there is no waiting period before using services. A case worker will be assigned to provide assistance, and record changes that may impact eligibility.

Applying for coverage can be completed online by completing a CPA (Combined Programs Application). Phone assistance is also available. Covered benefits include Preventative healthcare, dental, vision, ER, outpatient and inpatient hospital expenses, prescription drugs, pregnancy and prenatal care, drug and alcohol addiction, and HealthChek. Typically, a “managed care” plan must be chosen. The four available options in Ohio are:

UnitedHealthcare Community Plan

Molina Healthcare

CareSource

Buckeye Health Plan

Paramount Advantage

Healthchek

“Healthchek” provides newborns, children, and young adults (through age 20) preventative, diagnosis and treatment services. Ten checkups in the first two years along with follow-up annual checkups provide comprehensive healthcare. If additional treatment is required, Medicaid will pay for the expenses. NOTE: The program is also known as EPSDT (Early Periodic Screening, Diagnosis, and Treatment).

Each physical examination includes a medical history review, complete unclothed exam, vision and dental screening and other screenings and services, if recommended by the attending physician. Physical therapy benefits are actually more comprehensive than similar coverage offered to adults. Dental coverage is also more comprehensive than many plans offered to adults.

Other services include hearing and immunization assessments and additional diagnosis and treatment if a potential health problem is discovered. Any necessary lab tests and nutritional advice will also be provided. Additional information can be found here. Note: Newborns should utilize all 10 exams before their third birthday. By age three, only one exam is generally required each year. Physicians that accept Medicaid for insurance reimbursement, can also be used for Healthchek exams. If you move to a different county, a Healthchek Coordinator should be notified.

Preventive Benefits Are Covered By Ohio Medicaid

Medicaid Covered Benefits

The list is long and comprehensive, but we have highlighted the major coverage below:

Dental – Checkups and cleanings are provided every six months for persons under age 21 and annually for adults. A $3 copay applies to adult visits. Braces and orthodontia often require prior approval. Dentures and partial plates also must be approved. Fillings, extractions, root canals, and crowns are often covered. level of benefits are often determined based on medical necessity.

Vision – Medical and surgical benefits are provided along with annual vision checkup with one pair of glasses (every two years for adults). Screenings for Glaucoma are also covered.

Additional resources and initiatives include:

Balancing Incentive Program – Increased federal funding is utilized to improve long-term care services. Disabled persons and Seniors can live in non-conventional residences, and learn more about available services.

Electronic Visit Verification – Provides verification of services and the length of time they were performed. Private duty and home health nursing are included.

Payment Innovation – Quality of services rendered should be rewarded, as opposed to the volume of services provided.

MyCare Ohio – See below.

Disability Determination Changes – Several administrative procedures that determine eligibility were combined into one process. Persons impacted include the blind, aged, or disabled. “Spending down” is not required, and more lower-income individuals can qualify for benefits.

Budget Cost-Containment – Limiting per-member cost increases to less than 3% is the ultimate goal.

Transition Of Home And Community-Based Services – HCBS must meet specific guidelines and provide protections to persons receiving benefits.

Persons Receiving Both Medicaid And Medicare Benefits

Managed care benefits are available through MyCare Ohio, who provides long-term, medical, and behavioral coverage. Enrollment is required if you live in a “demonstration” county, are 18 or older, and currently are receiving Medicare and Medicaid benefits. A plan will be chosen for you, if you do not select a choice. Written confirmation will be sent, with the your deadline for enrollment. Behavioral support and long-term care is also provided. Note: You can compare Medicare Supplement plans in Ohio, and customize benefits and cost. Many levels of prescription drug coverage can also be chosen.

MyCare began in 2014 and provides benefits in 29 counties for more than 100,000 persons. Medicare-eligible applicants can retain their existing coverage. A “care team” helps coordinate your treatment. Members of the team include your primary-care physician, specialists, family members, case managers, and other medical personnel. Generally, reviews of your overall health are conducted regularly, and all treatment (if needed) is discussed. This system simplifies and organizes your benefits, since you have one main point of contact, instead of several persons in different cities.

Long-Term Care

Disabled and older adults often need assistance with routine daily activities, such as eating, getting mail, taking baths or showers, and preparing meals. LTC services help individuals and families enjoy a more routine and comfortable life, with Medicaid’s help. Specific services offered include private duty nursing (PDN), if the need is between 4 and 12 hours of continuous assistance. The personal-care physician (pcp) can help coordinate nurse’s care. Hospice services are also available for the terminally ill, and they can discontinue the benefits at any time.

President Donald Trump is sending Obamacare (Affordable Care Act) to its grave. Open Enrollment will change. The mandate requiring the purchase of compliant medical coverage will change. The American Health Care Act will be passed. And Ohio individual and family health insurance rates will go down. Or will they increase? So many unanswered questions and unquestioned answers.

With the help of Washington insiders, the Cleveland Indians, and our Seinfeld sense of humor, we present to you – “10 Things You Wanted To Know About Trumpcare, But Were Afraid To Ask.” Tongue and cheek, of course. Please enjoy!

How About That TrumpCare Health Insurance!

Individuals that complete an annual physical each year, and take no major medications, will be rewarded with a free three-night stay at any Trump resort in the world. Popular US destinations include New York, Chicago, Miami, and Las Vegas. Gold-plated faucets and curtains cost extra, although gold-colored blankets and sheets are standard. The mini-refrigerator comes with a full stock of food and beverages, including selections from Trump Winery.

“Trump Points” will be awarded to all persons that pay their out-of-pocket costs (copays, deductibles, and coinsurance) by the due date of the bill. If you pay 14 days early, an extra 1,000 “Trump Points” will be earned. At the end of the calendar year, you can redeem your points for great gifts, including electronic items, clothing, outdoor patio furniture, and shares of stock of Sears. If Sears files for bankruptcy, Walmart gift certificates will be available. Target and Kohls gift certificates are also available, for a slight cost.

Have you been thinking about getting an alarm system for your home to keep burglars away and strangers off your property? Congratulations! As part of an introductory promotion, the first 1 million persons to sign up for the new healthcare coverage will get their choice of a 10-feet wall built around their house or a 15-foot moat that surrounds the property. And by the way…Kentucky will pay for it. An optional swinging door pet gate will allow cats and dogs to enter the country, as long as they are spayed or neutered.

Cleveland’s Key Tower

The Key Tower, in downtown Cleveland, is the tallest building in Ohio, and the 24th tallest building in the US. It can be seen 20 miles away, and is home to KeyCorp. But the new Buckeye-Trump Tower will begin construction in late 2017 and will eventually be the home to Department of Health And Human Services (HHS) employees. It will replace the Key Tower at the tallest building in Ohio. And actually, it will become the tallest building in the world, reaching more than 27 miles in the sky. From the top floor, with a strong telescope, you’ll be able to see Uranus.

Health Savings Accounts (HSAs) will continue to be offered by most major insurers, with a new wrinkle. In addition to depositing tax-deferred dollars into your account, you will now be able to deposit “Trump Dollars” into your HSA. Available at most fine restaurants, grocery stores, and Ohio State football games, this new currency will have one advantage over regular US dollars. You can redeem any unused funds at the end of the year for several gifts, including gold-plated teeth, Long John Silver’s gift certificates, and free tickets to the Cincinnati Zoo.

A new 24-hour television network, “The Apprentice,” will be aired on Channel 146. It will also be aired on channels 151-289 and channels 14-75. New episodes will be filmed from the White House. A local “Ohio Apprentice” will be filmed at Kings Island, and aired on weekends only. Network programming will offer free healthcare tips and a free database of all Donald Trump press conferences within the last three years. Young entrepreneurs with great ideas can apply online to pitch their product.

TrumpCare “Preferred Status” will be awarded to all household members who don’t drink, smoke, or have a BMI (Body Mass Index) more than 15% of their recommended level. Special perks will include two free ER visits, a selfie with President Trump, or any other family member, and a lifetime free pass to the Pro Football Hall Of Fame in Canton. You’ll also receive free dried fruit snacks every month until you reach age 70.

The Cleveland Indians will be re-named the Cleveland Trumpeters, and all home games will be played in New York City. To accommodate season ticket holders, loyal baseball fans will be able to fly one-way from Cleveland at half-price. The return trip will be handled by Southwest Airlines, with all direct routes stopping in Chicago and Las Vegas, before heading back to Cleveland. Any passenger caught wearing any New York Yankees-related clothing, will be immediately deported.

Save Money With A Trump HSA

WSAs (Wall Savings Accounts) will also be created under the Trump Administration. The WSA (Wall Savings Account), will allow Ohio residents to contribute tax-free dollars to help pay for the wall separating the US and Mexico. For every dollar invested, two additional dollars will immediately become available to pay for policy copays, coinsurance, and deductibles. And as a special perk, free vacations to Cancun and Mexico City will be offered to every college student that graduates with at least a 3.5 GPA.

“Make Ohio Great Again” will become the new state motto, with souvenir t-shirts given out to every resident. As a special inducement to wear the t-shirt, when renewing driver’s licenses or vehicle registrations, a 25% discount will be applied to the cost, if the t-shirt is clearly visible. Any person who has the slogan on their pants, will receive a free vanity license plate with “Make Ohio Great Again” prominently displayed on the top and bottom.

As a condition for enrollment at Ohio State University (OSU), students are required to be covered under a qualified health insurance plan. This requirement applies to undergraduate students enrolled for six or more eligible credit hours (four or more eligible credit hours for graduate and professional students and three hours for post-candidacy students). You may choose to purchase private on and off-Marketplace coverage or the OSU option. You can also be covered under a parent’s private or employer-provided plan.

All international students must also meet these requirements, and are automatically enrolled in the “comprehensive” plan. Also, auto-enrolled are students that study overseas, interns, and persons working on dissertations or a thesis. However, if alternative qualified coverage is in-force, a waiver will be granted. If no selection is made, the comprehensive plan will automatically be selected. Generally, you must select a choice about seven days before August Semester classes begin.

When registering for classes for the first calendar year term, the Buckeye Link will indicate the cost of coverage for the comprehensive plan option. That coverage can be kept, or waived, with proof of another qualified policy. If waived, a supplementary WilceCare policy (discussed in detail later) also becomes available. NOTE: The annual period of coverage is August to August as opposed to using the calendar year.

Qualifying Events

If you miss the Enrollment/Select/Waive period for changes to the comprehensive plan, a 31-day period is granted if you qualify for a “qualifying event,” and submit the appropriate form to SHI. However, any form received after that period will not be considered. Coverage can be requested to be added or terminated. Examples are listed below:

Death of spouse, child, or dependent

Dependent no longer eligible for other coverage because of age restriction

Adding a spouse because of marriage

Deleting a dependent because of divorce

Dependent becomes US citizen

Adding a newborn from legal adoption or delivery

Dependent leaves country to return home

Employment change leads to new healthcare eligibility

Domestic partnership is terminated

2018 Rates

OSU student health insurance rates for 2018 are listed below. These rates are “per semester” with the plan offered and underwritten by UnitedHealthcare, one of the nation’s largest healthcare providers. Details of the OSU student health insurance plan can be viewed through the provided link. NOTE: Although UHC has greatly reduced their presence on state and federal Exchanges, it does not impact the specific plans offered at OSU. All of the options below satisfy ACA (Affordable Care Act) requirements and regulations, and include “minimum essential requirements.”

(Paid TWICE per year)

Student – $1,497

Student And Spouse – $2,994

Student And Child – $2,994

Student And Spouse And Child – $4,491

Student And Two Or More Children – $4,491

Student And Spouse And Two Or More Children – $5,988

Ohio State University Hospital Is One Of The Finest In The Midwest

Plan Overview

The policy provides comprehensive healthcare benefits, including coverage for office visits, prescriptions, Urgent Care and ER visits, major medical, mental illness, dental, and vision. If network facilities are utilized, maximum out-of-pocket expenses will be minimized. However, the UnitedHealthcare network is also available for off-campus treatment. Within the Franklin County PPO Network area, there are many available facilities. If purchased through the Federal Marketplace, the policy would closely resemble a Platinum-tier plan. NOTE: Picture above is property of OSU.

Additional specific network highlights include a low $150 deductible and $2,700 maximum out-of-pocket costs (in-network treatment). Both primary-care physician (PCP) and specialist office visits are subject to only a $20 copay with no limit on the number of covered visits. Also, no referrals are required. Vision and dental exams also feature the $15 copay.

“Tier 1” services are provided at the Wilce Student Health Center. By utilizing the facility, office visits, diagnostic lab tests and x-rays, allergy testing, treatment and injections, surgery, and outpatient procedures are covered at 100%. Also covered without any out-of-pocket expenses are durable medical equipment, and prosthetic devices.

The benefit package was recommended by the Student Health Insurance Advisory Committee and approved by the Board of Trustees. Additional benefits include:

100% qualified preventative benefits with no out-of-pocket costs.

10% coinsurance for diagnostic tests (blood work and x-rays), MRIs, and PET/CT scans.

Not all medical expenses are covered, regardless if treatment is performed in the Columbus area, or outside of Ohio. A partial listing of exclusions is listed below:

Experimental or unapproved surgery

Bariatric surgery

Cosmetic surgery

Hearing aids

Infertility treatment

Adult dental care

Weight loss programs

Long-term care

Foot care

If you receive treatment at the Wilce Student Health Center, usually there will be very little (or no) out-of-pocket cost. Qualified preventative expenses are covered with no out-of-pocket cost. This also applies to the UnitedHealthcare-provided benefits (Tiers 2 and 3). Common examples include: routine annual physicals, prostrate and testicular screening, breast cancer screening, well-visits, OBGYN exams, and colorectal cancer screening.

The WilceCare Supplement covers diagnostic lab tests and X-rays.

WilceCare Supplement Plan Option

If you opt out of the “comprehensive” option, and choose to utilize your own private plan, depending on your deductible and network benefits, higher out-of-pocket expenses could result, depending on the number of submitted claims. The WilceCare option is a pre-paid coverage that provides benefits for common ailments (and injuries). It is not a qualified insurance plan, and covered treatment must be provided at the Wilce Student Health Center during normal operating hours.

The two main components of the contract are prescription drugs and outpatient treatment. In-hospital expenses, or any services provided away from the Wilce Center are not covered. The Buck ID is the only identification needed for treatment. Major highlights of the rider are listed below:

Annual cost is $225. Spouses and dependents are not eligible for coverage.

$2,000 is the maximum amount of benefits paid for the contract year. Prescription drugs have a separate maximum of $225.

Prescription drugs for conditions that are covered under the program. Coinsurance is 10% for generic drugs, 20% for brand name drugs (no possible generic substitute offered), and 50% for brand name drugs with generic substitute available. A $10 copay also applies, unless the cost of the prescription is less.

For our comparison, we are assuming the insured is a healthy 20 year-old who lives in the Columbus area. It should be noted that rates vary, depending on where you live, your smoking status, and age. For this comparison, we did NOT include a federal subsidy, which can substantially lower premiums if you meet eligibility requirements. Listed below are some of the best plans to consider for student health coverage in Ohio. Rates are monthly:

There are many affordable student health insurance options and it’s very possible one of the plans listed above may be worth considering. Our contact information is listed at the top of the page and we are always available to discuss the best choices.

Summary

We continue to be recognized as the premier resource for all student medical coverage. You can view additional details here and view quotes live online. Often, purchasing your own private coverage is much less expensive and many benefits will be much more comprehensive. However, each situation is different so we’ll be happy to provide our unbiased advice and input.

It is also important to note that we are not affiliated with the OSU student health insurance program. However, optional coverage from many top-rated companies is very comprehensive, and rates are quite attractive. Specific questions regarding OSU student plan rates, coverage, eligibility requirements and enrollment details should be directed to this website. However, we also encourage comparing rates from all of the available carriers, not just one. Our quote section at the top of the page will help.